Despite thirty published evaluation reports citing the effectiveness of Vancouver’s safe injection site (Small 2008), the Canadian federal government refuses to endorse safe injection sites as a health service option available to injection drug users (IDUs). Insite’ s evaluation results are undergoing debate, because two communicative spheres of knowledge, each with a unique authoritative language, are conflicting as each is attempting to gain moral authority over the right to recontextualize drug users. Drawing on a literature review of two harm reduction programs in Vancouver, Insite and Sheway, and expert interviews with evaluators, I show that what constitutes “evidence” is in fact subjective, determined by spheres of communicability that are built upon social, professional and political contexts. To confront the problematic nature of this issue, I suggest that evaluators and overseers need to treat program evaluation as a process of negotiation, best approached in a fluid manner. By obscuring multiple user experiences in the evaluation of harm reduction programs, evaluators and overseers risk imposing their communicative ideologies on what it means to be a drug user.

Despite thirty published evaluation reports citing the effectiveness of Vancouver’s safe injection site (Small 2008), the Canadian federal government refuses to endorse safe injection sites as a health service option available to injection drug users (IDUs). Insite’ s evaluation results are undergoing debate, because two communicative spheres of knowledge, each with a unique authoritative language, are conflicting as each is attempting to gain moral authority over the right to recontextualize drug users. Drawing on a literature review of two harm reduction programs in Vancouver, Insite and Sheway, and expert interviews with evaluators, I show that what constitutes “evidence” is in fact subjective, determined by spheres of communicability that are built upon social, professional and political contexts. To confront the problematic nature of this issue, I suggest that evaluators and overseers need to treat program evaluation as a process of negotiation, best approached in a fluid manner. By obscuring multiple user experiences in the evaluation of harm reduction programs, evaluators and overseers risk imposing their communicative ideologies on what it means to be a drug user.

Despite thirty published evaluation reports citing the effectiveness of Vancouver’s safe injection site (Small 2008), the Canadian federal government refuses to endorse safe injection sites as a health service option available to injection drug users (IDUs). Insite’ s evaluation results are undergoing debate, because two communicative spheres of knowledge, each with a unique authoritative language, are conflicting as each is attempting to gain moral authority over the right to recontextualize drug users. Drawing on a literature review of two harm reduction programs in Vancouver, Insite and Sheway, and expert interviews with evaluators, I show that what constitutes “evidence” is in fact subjective, determined by spheres of communicability that are built upon social, professional and political contexts. To confront the problematic nature of this issue, I suggest that evaluators and overseers need to treat program evaluation as a process of negotiation, best approached in a fluid manner. By obscuring multiple user experiences in the evaluation of harm reduction programs, evaluators and overseers risk imposing their communicative ideologies on what it means to be a drug user. / Arts, Faculty of / Anthropology, Department of / Graduate

O sarcoma de aplicação felino (SAF) tornou-se um grande desafio para a Medicina Veterinária atual. Sua primeira descrição foi em 1991 e desde então inúmeros estudos estão sendo realizados objetivando a elucidação da etiologia e etiopatogenia do SAF. Esta pesquisa avaliou a eficácia do protocolo quimioterápico em SAF em dois grupos de animais: grupo I - com procedimento cirúrgico; grupo II - sem procedimento cirúrgico; avaliando a sobrevida destes pacientes. O diagnóstico de sarcoma de aplicação foi obtido através do histórico clínico de vacinação ou administração prévia no local do aparecimento do nódulo/formação inicial e da colheita de material para citologia, histopatologia e/ou imunohistoquímica. O diagnóstico de sarcoma de aplicação operável ou não foi proposto pelo pesquisador ao analisar os exames complementares, o estado geral do animal e pela avaliação das imagens da tomografia computadorizada. Os pacientes, nos quais o procedimento cirúrgico não foi viável, receberam como tratamento somente a aplicação de quimioterápico e para os operáveis após o procedimento cirúrgico foi instituído também o mesmo protocolo de quimioterapia. As imagens provindas da tomografia computadorizada também foram utilizadas na avaliação da resposta tumoral, redução ou manutenção do volume inicial, aos protocolos de tratamento instituídos. Para realização do projeto foram utilizados 12 felinos, encaminhados ao Serviço de Cirurgia de Pequenos Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. A partir do diagnóstico de sarcoma de aplicação não-operável, deu-se início ao protocolo quimioterápico de doxorrubicina não-encapsulada, na dose de 1 a 1.5mg/kg, intravenosa, a cada 21 dias, num total de quatro aplicações. E para os animais operados o protocolo de quimioterapia foi iniciado no 10º dia de pós-operatório. Antes de cada administração de quimioterapia foram realizados exames laboratoriais para verificar a condição clínica do paciente e as alterações oriundas do uso da quimioterapia, que pudessem impedir a aplicação no momento. O exame tomográfico foi passível de ser realizado em sete animais. A diferença da medida do volume tumoral pela tomografia foi estatisticamente significante em relação ao exame físico. Obteve-se melhor planejamento cirúrgico pela avaliação conjunta do exame físico e tomográfico. / The feline injection-site sarcoma (FISS) becomes a big challenge for Veterinary Medicine nowadays. Its first description was in 1991, and since then several studies have been done aiming to find out the FISS´s etiology and etiopathology. The object of this project is to demonstrate the effectiveness of chemotherapy protocols in FISS´s treatment in two groups of animals: one only with surgery and other without, where was evaluated the overall survival. The FISS diagnosis was obtained through to clinical data of vaccination or other injectable administration in the local of FISS appearance and with results of cytology, histopathology and/or immunohistochemical exams. Clinical data were collected on all patients, including any history of previous injection and complementary exams (computed tomography, cytology, and biopsy). The researcher with clinical data and exams results classified the tumors as resectable or nonresectable. With the clinical data and the results of the complementary exams the best treatment was applied. The patients with nonresectable tumors were treated with chemotherapy alone. The surgery was performed at "conform tumors surgery" in the patients in witch it was possible, and then chemotherapy was begun at 10-15 days before surgery. The treatment response was evaluated using tomography images too. The project selected 12 animals that were directed to Small Animal Surgery Service - HOVET - Faculty of Veterinary Medicine and Zootechny of University of São Paulo - São Paulo - Brazil. Chemotherapy protocol was with doxorubicin non-encapsulate at 1-1,5 mg/kg IV each 21 days/ 4 cycles. Chemotherapy was performed 10-15 days before in patients that they had made surgery. Complementary blood exams were made before each chemotherapy application with the intention to verify patient clinical condition and with intension to detect chemotherapy collaterals effects. The tomography exam was realized in 7 patients. The measurement of differences in clinical`s and tomography`s tumor volume was statistically significant (p=0,018). The surgery planning was better when the evaluation utilized the clinical data and the tomography exam.

O sarcoma de aplicação felino (SAF) tornou-se um grande desafio para a Medicina Veterinária atual. Sua primeira descrição foi em 1991 e desde então inúmeros estudos estão sendo realizados objetivando a elucidação da etiologia e etiopatogenia do SAF. Esta pesquisa avaliou a eficácia do protocolo quimioterápico em SAF em dois grupos de animais: grupo I - com procedimento cirúrgico; grupo II - sem procedimento cirúrgico; avaliando a sobrevida destes pacientes. O diagnóstico de sarcoma de aplicação foi obtido através do histórico clínico de vacinação ou administração prévia no local do aparecimento do nódulo/formação inicial e da colheita de material para citologia, histopatologia e/ou imunohistoquímica. O diagnóstico de sarcoma de aplicação operável ou não foi proposto pelo pesquisador ao analisar os exames complementares, o estado geral do animal e pela avaliação das imagens da tomografia computadorizada. Os pacientes, nos quais o procedimento cirúrgico não foi viável, receberam como tratamento somente a aplicação de quimioterápico e para os operáveis após o procedimento cirúrgico foi instituído também o mesmo protocolo de quimioterapia. As imagens provindas da tomografia computadorizada também foram utilizadas na avaliação da resposta tumoral, redução ou manutenção do volume inicial, aos protocolos de tratamento instituídos. Para realização do projeto foram utilizados 12 felinos, encaminhados ao Serviço de Cirurgia de Pequenos Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. A partir do diagnóstico de sarcoma de aplicação não-operável, deu-se início ao protocolo quimioterápico de doxorrubicina não-encapsulada, na dose de 1 a 1.5mg/kg, intravenosa, a cada 21 dias, num total de quatro aplicações. E para os animais operados o protocolo de quimioterapia foi iniciado no 10º dia de pós-operatório. Antes de cada administração de quimioterapia foram realizados exames laboratoriais para verificar a condição clínica do paciente e as alterações oriundas do uso da quimioterapia, que pudessem impedir a aplicação no momento. O exame tomográfico foi passível de ser realizado em sete animais. A diferença da medida do volume tumoral pela tomografia foi estatisticamente significante em relação ao exame físico. Obteve-se melhor planejamento cirúrgico pela avaliação conjunta do exame físico e tomográfico. / The feline injection-site sarcoma (FISS) becomes a big challenge for Veterinary Medicine nowadays. Its first description was in 1991, and since then several studies have been done aiming to find out the FISS´s etiology and etiopathology. The object of this project is to demonstrate the effectiveness of chemotherapy protocols in FISS´s treatment in two groups of animals: one only with surgery and other without, where was evaluated the overall survival. The FISS diagnosis was obtained through to clinical data of vaccination or other injectable administration in the local of FISS appearance and with results of cytology, histopathology and/or immunohistochemical exams. Clinical data were collected on all patients, including any history of previous injection and complementary exams (computed tomography, cytology, and biopsy). The researcher with clinical data and exams results classified the tumors as resectable or nonresectable. With the clinical data and the results of the complementary exams the best treatment was applied. The patients with nonresectable tumors were treated with chemotherapy alone. The surgery was performed at "conform tumors surgery" in the patients in witch it was possible, and then chemotherapy was begun at 10-15 days before surgery. The treatment response was evaluated using tomography images too. The project selected 12 animals that were directed to Small Animal Surgery Service - HOVET - Faculty of Veterinary Medicine and Zootechny of University of São Paulo - São Paulo - Brazil. Chemotherapy protocol was with doxorubicin non-encapsulate at 1-1,5 mg/kg IV each 21 days/ 4 cycles. Chemotherapy was performed 10-15 days before in patients that they had made surgery. Complementary blood exams were made before each chemotherapy application with the intention to verify patient clinical condition and with intension to detect chemotherapy collaterals effects. The tomography exam was realized in 7 patients. The measurement of differences in clinical`s and tomography`s tumor volume was statistically significant (p=0,018). The surgery planning was better when the evaluation utilized the clinical data and the tomography exam.

Supervised injection sites (SISs) have become subject to much political and social controversy in Canada since the late 1990s. Since the implementation of North America’s first SIS, Insite, in 2003 in Vancouver, the controversy has reached new levels. Despite the increasing evidence base available regarding the effectiveness of SISs as a harm reduction strategy trans-nationally, the implementation of this intervention in Canada prevails within public and parliamentary debates. Guided by the theoretical contributions of Joel Best (2008) on claims-making and the construction of social problems, this thesis explores the SIS debate in Canada and the assertions advanced with respect to the implementation of SISs. Building on the available literature, the author identifies numerous types of claims advanced by proponents and opponents of SISs through a qualitative content analysis of 164 newspaper documents from The Vancouver Sun, The Ottawa Sun and The Ottawa Citizen. It was determined that claimsmakers often present the intervention as a solution to the ‘drug problem’ or part in parcel of the problem. Opponents in particular attempt to construct the intervention as harmful for the community in that the implementation of a SIS would exacerbate various aspects of the ‘drug problem’ including drug abuse and crime. Very rarely, however, claimsmakers suggest the SIS is merely one strategy to addressing public health issues related to injection drug use and that there is ‘no easy fix’ to this ‘drug problem’. Further, the author applies the findings from this analysis to make sense of the Canadian federal government’s proposed policy response, The Respect for Communities Act, towards the establishment of SISs.

Background: Opioid overdoses have killed almost 20,000 Canadians since 2016. To address this, Canada has established supervised consumption sites where people can use drugs in the presence of trained staff and get access to pharmacological treatments such as methadone. However, there is very little research on whether supervised consumption clients use methadone, or whether their use of methadone prevents opioid overdose. Methods: A secondary data analysis of information collected from one supervised consumption site was undertaken in order to explore relationships between client self-reported methadone dosage and subsequent observed same-day opioid overdose. Results: Statistical analysis showed no correlation between methadone usage and reduced chance of opioid overdose. However, the most common dosage of methadone reported (30mg/day) was far below the minimum therapeutic dose of methadone. Conclusion: Clients of supervised consumption sites often report being prescribed methadone, but not at a dose high enough to reduce opioid overdose.

O Sarcoma de Aplicação Felino (SAF) possui características específicas pouco estudadas. A agressividade, com invasão profusa de tecidos adjacentes, bem como a presença de células anaplásicas em sua composição fazem do SAF um obstáculo a ser transposto, para obtenção do melhor tratamento. Sua etiologia e etiopatogenia ainda permanecem obscuras. O objetivo deste estudo consistiu em determinar fatores prognósticos para o paciente portador de SAF, caracterizando-o quanto ao seu peso e escore de condição corporal (ECC), à origem e diferenciação da neoplasia por ele apresentada, bem como caracterizar o microambiente perineoplásico quanto à presença de células inflamatórias. Foram selecionados 46 casos de SAF, sendo 31 casos novos de pacientes e 22 casos reavaliados. Foi encontrada diferença significativa entre o ECC (p=0,001) e peso (p<0,001) de pacientes que apresentaram SAF e os do grupo controle. Não foram encontradas diferenças entre gênero e raça. A localização mais comumente acometida foi a tóraco-abdominal (78%). Quanto à origem, a maioria dos SAF apresentou-se como originada em células fibroblastos. Enquanto não houve marcação para componentes inflamatórios (CD3 e CD68), houve para receptor de quinase (c-kit), para Cox-2 e FelV. Não houve influencia dos parâmetros avaliados com as variáveis clínicas e com a sobrevida total. Houve influencia estatisticamente significante quando comparamos a invasão observada no exame de tomografia computadorizada e a escolha do tratamento instituído (p=0,019). / The feline injection-site sarcoma (FISS) has specific characteristics which are little studied. FISS treatment is a hurdle to getting because of their aggressiveness, with profuse invasion of adjacent tissue, as well as the presence of anaplastic cells in its composition. Its etiology and pathogenesis remain obscure. This research aims to determine prognostic factors for patients with FISS, characterizing it as their weight and body condition score (BCS) and by the origin and differentiation of the tumor presented, along with characterizing the microenvironment peri-neoplastic for the presence of inflammatory cells. 46 cases of cats that presented FISS were assisted, with 31 new cases and 22 cases of patients reassessed. Statistical difference was found between the BCS (p=0,001) and weight (p<0,001) of FISS group and control group. No differences were found between gender and race. The region most commonly affected was the toraco-abdominal (78%). The FISS majority presented as fibroblasts origin, while no marking for inflammatory components (CD3 and CD68). There was marking for kinases cascade (c-KIT), for COX-2, and for FelV. There was no influence of the parameters evaluated with clinical variables and overall survival. There was a statistically significant influence when comparing the invasion observed in computerized tomographic examination and choice of the treatment (p = 0.019).

O sarcoma de aplicação em felinos (SAF) é uma neoplasia rara de origem mesenquimal e com prognóstico desfavorável que se desenvolve em local previamente utilizado para aplicações de medicamentos injetáveis ou submetido a traumas. Poucos estudos foram encontrados na literatura descrevendo os aspectos imaginológicos do SAF. O objetivo dessa pesquisa foi descrever os aspectos das imagens de tomografia computadorizada e ultrassonografia do SAF (modo B e Doppler colorido e amplitude), verificando características comuns, particularidades da formação recidivante e correlações com variáveis clínicas. A pesquisa contemplou uma fase prospectiva e outra retrospectiva, totalizando 32 felinos. Ao exame tomográfico, observou-se com maior frequência formas neoplásicas irregulares (62,5%), com prolongamentos digitiformes (100%), realce periférico e heterogêneo (67,7%), borramento dos planos adiposos (68,8%) e áreas sugerindo necrose intratumoral (68,8%). Ao exame ultrassonográfico observou-se contornos irregulares, presença de halo hiperecogênico, ecotextura heterogênea, tecido hiperecogênico contíguo à formação e espessamento hipoecogênico do subcutâneo adjacente, além de ecogenicidade mista, devido à presença de áreas sugerindo necrose intratumoral (83,3%). Ao estudo Doppler, observou-se distribuição vascular mais evidente na região periférica (83,3%), com calibre homogêneo (83,3%), fluxo regular (50%) e misto (50%). A quantidade de vasos neoplásicos detectados pela TC foi maior do que por US Doppler (p=0,024). O volume e o tempo de evolução da formação apresentaram alta correlação nos casos não recidivantes (p<0,001). A presença de metástase salteada foi mais comum em formações recidivantes (p=0,001). O uso de meio de contraste intravenoso e do recurso MPR permitiu melhor delimitação das margens da formação pela TC e uma mensuração neoplásica mais criteriosa. Os histogramas revelaram uma quantidade representativa de gordura na composição do SAF, e foi observada quantidades superiores de músculos acometidos na presença de um espessamento da gordura adjacente à formação (p=0,003). Os exames de diagnóstico por imagem foram importantes para caracterização do SAF, especialmente no que se refere a delimitação de suas margens e na avaliação dos tecidos adjacentes, além de fornecerem informações relevantes para o estadiamento neoplásico e para terapêutica. / The feline injection-site sarcoma (FIIS) is a rare mesenchymal neoplasm and has poor prognosis. It develops in a site previously used for intravenous applications or undergone trauma. Few studies were found in the literature describing the imaging features of FIIS. The aim of this research was to describe computed tomographic (CT) and ultrasonographic (B mode, color and power Doppler) images of FIIS to find common characteristics, particularities of disease recurrence and correlations with clinical variables. The study had a prospective and a retrospective phases, totaling 32 cats. At the CT scan it was observed more frequently an irregular neoplastic forms (62,5%) with fingerlike projections (100%), peripheral and heterogeneous enhancements (67,7%), blurring of the adjacent fat (68,8%) and areas suggesting intratumoral necrosis (68,8%). At the ultrasound it was observed irregular outlines, with hyperechoic halo, heterogeneous echotexture, hyperechogenic tissue adjacent at the tumor and thickening of the adjacent hypoechogenic subcutaneous tissue. Mixed echogenicity with areas suggesting intratumoral necrosis was generally observed (83,3%). Doppler study showed more evident vascular distribution in the peripheral region (83,3%) with homogeneous diameter (83,3%), smooth (50%) and mixed (50%) flow. The quantity of tumor vessels was higher at CT than Doppler ultrasound (p=0,024). The presence of a vessel tumor coming from vessels of the abdominal cavity on CT may be an important finding for surgical planning. Tumor volume and time of presentation were correlated with non-recurrent cases (p<0,001). Skip metastasis showed high correlation with recurrent cases (p=0,001). The use of postcontrast phase at CT scans and MPR allowed better delineation of tumor margins and a more carreful measurement. Histograms revealed a representative amount of fat in tumor composition. A tendency of higher amounts of muscles being involved was observed with fat thickening near the tumor (p=0,003). Diagnostic imaging was important to characterization of FIIS, especially to delimitate tumor extension, evaluate compromised adjacent tissues providing relevant information for tumor staging and therapeutic planning.

O sarcoma de aplicação em felinos (SAF) é uma neoplasia rara de origem mesenquimal e com prognóstico desfavorável que se desenvolve em local previamente utilizado para aplicações de medicamentos injetáveis ou submetido a traumas. Poucos estudos foram encontrados na literatura descrevendo os aspectos imaginológicos do SAF. O objetivo dessa pesquisa foi descrever os aspectos das imagens de tomografia computadorizada e ultrassonografia do SAF (modo B e Doppler colorido e amplitude), verificando características comuns, particularidades da formação recidivante e correlações com variáveis clínicas. A pesquisa contemplou uma fase prospectiva e outra retrospectiva, totalizando 32 felinos. Ao exame tomográfico, observou-se com maior frequência formas neoplásicas irregulares (62,5%), com prolongamentos digitiformes (100%), realce periférico e heterogêneo (67,7%), borramento dos planos adiposos (68,8%) e áreas sugerindo necrose intratumoral (68,8%). Ao exame ultrassonográfico observou-se contornos irregulares, presença de halo hiperecogênico, ecotextura heterogênea, tecido hiperecogênico contíguo à formação e espessamento hipoecogênico do subcutâneo adjacente, além de ecogenicidade mista, devido à presença de áreas sugerindo necrose intratumoral (83,3%). Ao estudo Doppler, observou-se distribuição vascular mais evidente na região periférica (83,3%), com calibre homogêneo (83,3%), fluxo regular (50%) e misto (50%). A quantidade de vasos neoplásicos detectados pela TC foi maior do que por US Doppler (p=0,024). O volume e o tempo de evolução da formação apresentaram alta correlação nos casos não recidivantes (p<0,001). A presença de metástase salteada foi mais comum em formações recidivantes (p=0,001). O uso de meio de contraste intravenoso e do recurso MPR permitiu melhor delimitação das margens da formação pela TC e uma mensuração neoplásica mais criteriosa. Os histogramas revelaram uma quantidade representativa de gordura na composição do SAF, e foi observada quantidades superiores de músculos acometidos na presença de um espessamento da gordura adjacente à formação (p=0,003). Os exames de diagnóstico por imagem foram importantes para caracterização do SAF, especialmente no que se refere a delimitação de suas margens e na avaliação dos tecidos adjacentes, além de fornecerem informações relevantes para o estadiamento neoplásico e para terapêutica. / The feline injection-site sarcoma (FIIS) is a rare mesenchymal neoplasm and has poor prognosis. It develops in a site previously used for intravenous applications or undergone trauma. Few studies were found in the literature describing the imaging features of FIIS. The aim of this research was to describe computed tomographic (CT) and ultrasonographic (B mode, color and power Doppler) images of FIIS to find common characteristics, particularities of disease recurrence and correlations with clinical variables. The study had a prospective and a retrospective phases, totaling 32 cats. At the CT scan it was observed more frequently an irregular neoplastic forms (62,5%) with fingerlike projections (100%), peripheral and heterogeneous enhancements (67,7%), blurring of the adjacent fat (68,8%) and areas suggesting intratumoral necrosis (68,8%). At the ultrasound it was observed irregular outlines, with hyperechoic halo, heterogeneous echotexture, hyperechogenic tissue adjacent at the tumor and thickening of the adjacent hypoechogenic subcutaneous tissue. Mixed echogenicity with areas suggesting intratumoral necrosis was generally observed (83,3%). Doppler study showed more evident vascular distribution in the peripheral region (83,3%) with homogeneous diameter (83,3%), smooth (50%) and mixed (50%) flow. The quantity of tumor vessels was higher at CT than Doppler ultrasound (p=0,024). The presence of a vessel tumor coming from vessels of the abdominal cavity on CT may be an important finding for surgical planning. Tumor volume and time of presentation were correlated with non-recurrent cases (p<0,001). Skip metastasis showed high correlation with recurrent cases (p=0,001). The use of postcontrast phase at CT scans and MPR allowed better delineation of tumor margins and a more carreful measurement. Histograms revealed a representative amount of fat in tumor composition. A tendency of higher amounts of muscles being involved was observed with fat thickening near the tumor (p=0,003). Diagnostic imaging was important to characterization of FIIS, especially to delimitate tumor extension, evaluate compromised adjacent tissues providing relevant information for tumor staging and therapeutic planning.